Combined Effect of Early Physical Exercise and Stereotactic Hematoma Evacuation in Patients with Cerebral Hemorrhage Undergoing Hemodialysis.

Objective: This study investigated the combined effect of stereotactic hematoma evacuation and early postoperative physical function exercise in hemodialysis patients with cerebral hemorrhage. Methods: A retrospective study was conducted, including a total of 78 hemodialysis patients with cerebral hemorrhage treated at our hospital between January 2021 and June 2022. The patients were equally allocated to two groups based on different postoperative rehabilitation methods. The control group underwent stereotactic hematoma evacuation, while the study group received additional early postoperative physical function exercise in addition to the intervention provided to the control group. The operative conditions of both groups were recorded, and comparisons were made concerning neural function, limb function, daily activity ability, and complications. Results: There were no significant differences between the two groups regarding operation time, intraoperative blood loss, and hematoma removal rate (P > .05). However, the study group demonstrated a significantly shorter hospital stay (12.98 ± 2.01 days) compared to the control group (15.02 ± 2.07 days), P < .05. Post-treatment, the study group exhibited substantially lower neurological function scores (NIHSS score) (6.37 ± 1.02) compared to the control group (10.03 ± 1.09), P < .05. Additionally, the study group showed significantly higher limb function scores (P < .05) and daily activity ability scores (P < .05) compared to the control group. Moreover, the incidence of complications in the study group was significantly lower than that in the control group (P < .05). Conclusions: Early postoperative physical function exercise following stereotactic hematoma evacuation showed beneficial effects in hemodialysis patients with cerebral hemorrhage. It effectively reduced operation time, restored nerve and limb function, improved daily activity ability, and reduced the incidence of related complications. These approaches hold crucial clinical significance.

Clinical application of 3DSlicer and Sina in minimally invasive puncture drainage of elderly patients with spontaneous intracerebral hemorrhage under local anesthesia.

BACKGROUND: Decreased organ function and poor physical compensatory capacity in elderly patients diagnosed with spontaneous intracerebral hemorrhage (ICH) can make surgical treatment procedures challenging and risky. Minimally invasive puncture drainage (MIPD) combined with urokinase infusion therapy is a safe and feasible method of treating ICH. This study aimed to compare the treatment efficacy of MIPD conducted under local anesthesia using either 3DSlicer + Sina application or computer tomography (CT)-guided stereotactic localization of hematomas in elderly patients diagnosed with ICH. METHODS: The study sample included 78 elderly patients (≥ 65 years of age) diagnosed with ICH for the first time. All patients exhibited stable vital signs and underwent surgical treatment. The study sample was randomly divided into two groups, either receiving 3DSlicer+Sina or CT-guided stereotactic assistance. The preoperative preparation time; hematoma localization accuracy rate; satisfactory hematoma puncture rate; hematoma clearance rate; postoperative rebleeding rate; Glasgow Coma Scale (GCS) score after 7 days; and modified Rankin scale (mRS) score 6 months after surgery were compared between the two groups. RESULTS: No significant differences in gender, age, preoperative GCS score, preoperative hematoma volume (HV), and surgical duration were observed between the two groups (all p-values > 0.05). However, the preoperative preparation time was shorter in the group receiving 3DSlicer + Sina assistance compared to that receiving CT-guided stereotactic assistance (p-value < 0.001). Both groups exhibited significant improvement in GCS scores and reduction in HV after surgery (all p-values < 0.001). The accuracy of hematoma localization and puncture was 100% in both groups. There were no significant differences in surgical duration, postoperative hematoma clearance rate, rebleeding rate, postoperative GCS and mRS scores between the two groups (all p-values > 0.05). CONCLUSIONS: A combination of 3DSlicer and Sina is effective in accurately identifying hematomas in elderly patients with ICH exhibiting stable vital signs, thus simplifying MIPD surgeries conducted under local anesthesia. This procedure may also be preferred over CT-guided stereotactic localization in clinical practice due to its ease of use and accuracy in hematoma localization.

Efficacy of Laparoscopic Totally Extraperitoneal Repair for Inguinal Hernia.

Objective: To assess the treatment efficacy of laparoscopic totally extraperitoneal repair for inguinal hernia. Methods: Between November 2018 and May 2020, 130 patients with inguinal hernias diagnosed and treated in our hospital were randomly recruited and assigned to receive either tension-free hernia repair (control group) or laparoscopic totally extraperitoneal repair (study group) at the random method. All patients received routine care including external traditional Chinese medicine (TCM) application. Outcome measures included surgical indices, numeric rating scale (NRS) scores, infections, and postoperative complications. Results: Laparoscopic surgery is associated with a shorter operation duration, time-lapse before postoperative off-bed activity, and hospital stay, as well as less intraoperative hemorrhage volume compared to tension-free hernia repair in the control group. Patients in the study group had considerably lower NRS ratings after therapy than those in the control group. (P < 0.05). After treatment, the levels of blood cell count (WBC), C-reactive protein (CRP), and procalcitonin (PCT) in the study group were lower than those in the control group (P < 0.05). In the control group, there were 0 cases of hematoma, 3 cases of subcutaneous effusion, 4 cases of urinary retention, 5 cases of scrotal effusion, and 1 case of bladder injury. In the study group, there were 0 cases of hematoma, 1 case of subcutaneous fluid, 1 case of urinary retention, 0 cases of scrotal fluid, and 0 cases of bladder injury. Laparoscopic surgery resulted in a lower incidence of postoperative complications versus traditional surgery (P <0.05). Conclusion: Laparoscopic totally extraperitoneal repair for inguinal hernia improves the intraoperative indices, mitigates postoperative pain, and reduces the risks of infections and complications, with the advantages of short operation duration, less hemorrhage volume, and shorter hospital stay. It shows great potential for clinical promotion.

Breaking the Binary: The Approach to Chest Masculinizing Gender-Affirming Surgery in Trangender Men.

BACKGROUND: The purpose of mastectomy for the transgender patient is to produce a masculine appearance of the chest. A number of algorithms have been proposed for selecting the surgical technique. A holistic and surgical approach to transgender men includes our experience-based classification system for selecting the correct surgical technique. OBJECTIVES: To present and discuss the Transgender Standard of Care and our personal experience. METHODS: Data were collected from the files of female-to-male transgender persons who underwent surgery during 2003-2019. Pictures of the patients were also analyzed. RESULTS: Until May 2021, 342 mastectomies were performed by the senior author on 171 patients. The 220 mastectomies performed on 110 patients until November 2019 were included in our cohort. Patient age was 13.5 to 50 years (mean 22.5 ± 6.1). The excision averaged 443 grams per breast (range 85-2550). A periareolar approach was performed in 14 (12.7%), omega-shaped resection (nipple-areola complex on scar) in 2 (1.8%), spindle-shaped mastectomy with a dermal nipple-areola complex flap approach in 38 (34.5%), and a complete mastectomy with a free nipple-areola complex graft in 56 (50.9%). Complications included two hypertrophic scars, six hematomas requiring revision surgery, three wound dehiscences, and three cases of partial nipple necrosis. CONCLUSIONS: A holistic approach to transgender healthcare is presented based on the World Professional Association for Transgender Health standard of care. Analysis of the data led to Wolf's classification for female-to-male transgender mastectomy based on skin excess and the distance between the original and the planned position of the nipple-areola complex.

Chronic Encapsulated Expanding Hematoma After Gamma Knife Thalamotomy for Essential Tremor.

There have been no previous reports of chronic encapsulated expanding hematoma after Gamma Knife thalamotomy. The present case underwent Gamma Knife thalamotomy for essential tremor at the age of 78 years. Three- and 12-month posttreatment magnetic resonance imaging (MRI) showed small T2 high-intensity lesions on the target and along with the internal capsule. Hemiparesis developed 17 months after the treatment. Twenty months post treatment, T2-MRI showed a hypointense mass across the target and internal capsule. Gradual expansion of the mass was confirmed on MRI at 26-38 months. A 54-month posttreatment MRI showed marked expansion of the mass with multiple cysts surrounded by a T2-hypointense rim. Gadolinium-enhanced T1-MRI showed partial enhancement of the mass. MRI findings suggested a radiation-induced cavernoma. Hemiparesis, dysesthesia, and pain on the right side of the body persisted even after steroid therapy for several months. Long-term careful observation is necessary after Gamma Knife thalamotomy.

Intraventricular Hemorrhage Expansion in the CLEAR III Trial: A Post Hoc Exploratory Analysis.

BACKGROUND: The objective of this study was to evaluate factors associated with intraventricular hemorrhage (IVH) expansion and its association with long-term outcomes. METHODS: We performed a post hoc analysis of the international, multi-center CLEAR III trial (Clot Lysis: Evaluating Accelerated Resolution of Intraventricular Hemorrhage) which enrolled IVH patients between September 1, 2009, and January 31, 2015. The exposure was IVH expansion, defined as >1 mL increase in volume between baseline and stability computed tomography scans, before treatment randomization. We assessed factors associated with IVH expansion and secondarily assessed the relationship of IVH expansion with clinical outcomes: composite of death or major disability (modified Rankin Scale score, >3), and mortality alone at 6 months. The relationship of IVH expansion on ventriculoperitoneal shunt placement was additionally explored. Multivariable logistic regression was used for all analyses. RESULTS: Of 500 IVH patients analyzed, the mean age was 59 (±11) years old, 44% were female and 135 (27%) had IVH expansion. In multivariable regression models, factors associated with IVH expansion were baseline parenchymal intracerebral hemorrhage (ICH) volume (adjusted odds ratio [OR], 1.04 per 1 mL increase [95% CI, 1.01-1.08]), presence of parenchymal hematoma expansion: >33% (adjusted OR, 6.63 [95% CI, 3.92-11.24]), time to stability head CT (adjusted OR, 0.71 per 1 hour increase [95% CI, 0.54-0.94]), and thalamic hematoma location (adjusted OR, 1.68 [95% CI, 1.01-2.79]) while additionally adjusting for age, sex, and race. In secondary analyses, IVH expansion was associated with higher odds of poor 6-month outcomes (adjusted OR, 1.84 [95% CI, 1.12-3.02]) but not mortality (OR, 1.40 [95% CI, 0.78-2.50]) after adjusting for baseline ICH volume, thalamic ICH location, age, anticoagulant use, Glasgow Coma Scale score, any withdrawal of care order, and treatment randomization arm. However, there were no relationships of IVH expansion on subsequent ventriculoperitoneal shunt placement (adjusted OR, 1.02 [95% CI, 0.58-1.80]) after adjusting for similar covariates. CONCLUSIONS: In a clinical trial cohort of patients with large IVH, acute hematoma characteristics, specifically larger parenchymal volume, hematoma expansion, and thalamic ICH location were associated with IVH expansion. Given that IVH expansion resulted in poor functional outcomes, exploration of treatment approaches to optimize hemostasis and prevent IVH expansion, particularly in patients with thalamic ICH, require further study. REGISTRATION: URL: https://www. CLINICALTRIALS: gov; Unique identifier: NCT00784134.

Functional Outcome After Minimally Invasive Endoscopic Evacuation of Thalamic Intracerebral Hemorrhage.

BACKGROUND: Intracerebral hemorrhage (ICH) is the most devastating form of stroke, with thalamic hemorrhages carrying the worst outcomes. Minimally invasive (MIS) endoscopic ICH evacuation is a promising new therapy for the condition. However, it remains unclear whether therapy success is location dependent. Here we present long-term functional outcomes after MIS evacuation of spontaneous thalamic hemorrhages. METHODS: Patients presenting to a single urban health system with spontaneous ICH were triaged to a central hospital for management of ICH. Operative criteria for MIS evacuation included hemorrhage volume ≥15 mL, age ≥18, National Institutes of Health Stroke Scale ≥6, and baseline modified Rankin Score (mRS) ≤3. Demographic, radiographic, and clinical data were collected prospectively, and descriptive statistics were performed retrospectively. Functional outcomes were assessed using 6-month mRS scores. RESULTS: Endoscopic ICH evacuation was performed on 21 patients. Eleven patients had hemorrhage confined to the thalamus, whereas 10 patients had hemorrhages in the thalamus and surrounding structures. Eighteen patients (85.7%) had intraventricular extension. The average preoperative volume was 39.8 mL (standard deviation [SD]: 31.5 mL) and postoperative volume was 3.8 mL (SD: 6.1 mL), resulting in an average evacuation rate of 91.4% (SD: 11.1%). One month after hemorrhage, 2 patients (9.5%) had expired and all other patients remained functionally dependent (90.5%). At 6-month follow-up, 4 patients (19.0%) had improved to a favorable outcome (mRS ≤ 3). CONCLUSION: Among patients with ICH undergoing medical management, those with thalamic hemorrhages have especially poor outcomes. This study suggests that MIS evacuation can be safely performed in a thalamic population. It also presents long-term functional outcomes that can aid in planning randomization schemes or subgroup analyses in future MIS evacuation clinical trials.

Naoxueshu relieves hematoma after clot removal in acute spontaneous intracerebral hemorrhage.

OBJECTIVES: Surgical treatment is expected to remove clot immediately in acute spontaneous intracerebral hemorrhage (SICH) patients. The aim of this study was to evaluate whether Naoxueshu could enhance the efficacy of clot removal surgery in acute SICH patients. METHODS: One hundred twenty patients who had been diagnosed as SICH according to neuroimaging were enrolled in this study. They received craniotomy, decompressive craniectomy, or minimally invasive surgical evacuation as appropriate and then were randomized into two groups: the Naoxueshu group (NXS group, n = 60) and the control group (n = 60). All the patients received standard medical management while patients in NXS group also took Naoxueshu oral liquid 10 ml with three times a day for seven consecutive days. The primary outcome was the 7-day hematoma volume and secondary outcomes were 7-day National Institutes of Health Stroke Scale (NIHSS) score and 7-day cerebral edema score. RESULTS: After clot removal surgery, hematoma volume in NXS group (9.5 ± 8.0) was significantly decreased than that in Control group (21.3 ± 22.9, p < .0001) 7 days after surgery. Moreover, cerebral edema was also relieved after 7-day's Naoxueshu treatment (2.5 ± 0.9 vs. 2.9 ± 0.7, p = .043). Since patients in NXS group had worse baseline NIHSS score (17.2 ± 8.1 vs. 13.7 ± 10.1, p = .039), it was reasonable to conclude that Naoxueshu treatment could improve patients' neurological function because 7-day NIHSS score of the two groups was similar. CONCLUSION: Naoxueshu oral liquid could relieve hematoma volume and cerebral edema after clot removal surgery in acute SICH patients. Moreover, it had the potential to improve patients' short-term neurological function.

Endoscopic hematoma removal of supratentorial intracerebral hemorrhage under local anesthesia reduces operative time compared to craniotomy.

The surgical efficacy for supratentorial intracerebral hemorrhage (ICH) remains unknown. We compared the advantages of the widely practiced endoscopic hematoma removal under local anesthesia with that of craniotomy under general anesthesia for ICH. We also focused on our novel operative concept of intentional hematoma leaving technique to avoid further damage to the brain. We retrospectively analyzed 134 consecutive patients (66 endoscopies and 68 craniotomies) who were surgically treated for supratentorial ICH. The characteristics of the 134 patients were as follows: The median (interquartile range) age was 73 (61-82) years. The median Glasgow Coma Scale scores at admission, on day 7, and the median modified Rankin Scale (mRS) score at 6 months were 10 (7-13), 13 (10-14), and 4 (3-5) respectively. The statistical comparison revealed there were no differences in GCS score on day seven between the endoscopy 13 (12-14) and craniotomy group 12 (9-14). No differences were observed in mRS scores at 6 months between the endoscopy 4 (2-5) and craniotomy group 4 (3-5). However, the patients treated with our technique tended to have favorable outcomes. Multivariate analysis revealed the operative time was significantly decreased in the endoscopy group compared to the craniotomy group (p < 0.001).

Training Room Procedures and Use of Therapeutic Modalities in Athletes.

Athletic trainers, physical therapists, and team physicians have differing roles when providing care, yet often need to collaborate. Athletic trainers and physical therapists use a variety of therapeutic modalities and manual therapy techniques in conjunction with rehabilitation exercises to improve outcomes. Clinicians must be knowledgeable of the scientific rationale for each modality to choose the most effective treatment for the specific condition and stage of recovery. The team physician should be familiar with the use of common procedures in an athletic training room. Here, we review the most current evidence and the basic methods encountered in athletic training room settings.

Do Not Use Water Jets on Skin Hematoma.

Morel-Lavallée lesions are posttraumatic hemolymphatic collections related to shearing injury of variable mechanism (severe trauma or low-velocity crush injury), resulting in disruption of interfacial planes between subcutaneous soft tissue and muscle and perforating lymphatics and blood vessels. A 69-y-old woman, without medical history, was admitted to the emergency ward for important pain located from her behind to the anterior face of the thighs. Physical examination revealed large semirecent hematoma with a large soft fluctuant area with hypermobility of the skin and cutaneous hyperesthesia, spreading from her behind to the anterior face of her thigs. Her symptoms were typical of a Morel-Lavallée lesion. The ultrasound examination revealed hypoechoic heterogeneous compressible fluid containing fat debris with irregular margins and lobular shape, localized between subcutaneous fat and deep fascia, without flow on color Doppler, confirming the acute Morel-Lavallée lesion. After evacuation by needle puncture, the collection reappearance was probably due to hemolymphatic fluid corresponding to type 1 of the Mellado and Bencardino classification of Morel-Lavallée lesions. Patients and Physicians should be aware of the worsening effects of balneotherapy on skin hematoma to prevent dramatic extension of Morel-Lavallée lesions.

Spontaneous prostatic haematoma in a case of benign prostatic hyperplasia.

A 61-year-old man presented with urinary retention with obstructive uropathy (urea/creatinine: 126/9.2 mg/dL) secondary to a large prostatic haematoma while being medically managed for benign enlargement of the prostate. The patient did not have any fever or local symptoms and the prostate was enlarged and non-tender on examination. Ultrasound and MRI of the pelvis showed a 9.4×10.4×11.1 cm sized prostatic haematoma seen displacing and compressing the urinary bladder anteriorly with bilateral hydroureteronephrosis. The patient was managed with per-urethral catheterisation, haemodialysis and injectable antibiotics. Percutaneous pigtail placement into the prostatic haematoma led to gradual drainage of the haematoma with improvement in the renal parameters. Definitive surgery in the form of transurethral resection of the prostate was done at a later date. Intraoperatively multiple encapsulated cavities containing organised clots were deroofed. On follow-up, the patient did well and had good urinary flow and normal renal parameters.

Endoscopic Hematoma Evacuation for Intracerebral Hemorrhage Under Local Anesthesia: Factors That Affect the Hematoma Removal Rate.

OBJECTIVE: Recent advances in endoscopic surgery have led to more patients being able to undergo endoscopic removal of hypertensive intracerebral hemorrhage (HICH). However, because of the minimal invasiveness, endoscopic HICH removal through a narrow surgical window can result in a low removal rate. The goal of the present study was to investigate the factors that affect the removal rate of HICH evacuation. METHODS: The data from 28 patients with supratentorial HICH who had undergone endoscopic hematoma evacuation were retrospectively analyzed. The inclusion criteria were spontaneous supratentorial HICH with a hematoma volume >30 mL, admission to the hospital within 24 hours of ictus, and a Glasgow coma scale score of ≥4. RESULTS: Of the 28 patients, 9 were women and 19 were men, ranging in age from 41 to 86 years (mean, 60.7 ± 12.7). The hematoma location was the basal ganglia in 25 patients and subcortical in 3 patients. The mean preoperative hematoma volume was 62.4 ± 22.5 mL. The hematoma removal rate was <60% for 11 patients (poor evacuation group) and ≥60% for in 17 patients (good evacuation group). Comparing the 2 groups, chronic renal failure treated with hemodialysis (P = 0.0072, χ2 test), liver cirrhosis (P = 0.023, χ2 test), and surgeon experience with ≥10 cases of endoscopic HICH removal (P = 0.016, χ2 test) were significant factors related to the HICH removal rate. CONCLUSION: To achieve a good removal rate, surgeons should have experience performing the endoscopic procedure. Also, patients with end-stage chronic renal failure or liver cirrhosis should be excluded.

The Clinical Efficacy of Electromagnetic Navigation-Guided Hematoma Puncture Drainage in Patients with Hypertensive Basal Ganglia Hemorrhage.

OBJECTIVE: To investigate the clinical efficacy of navigation-guided minimally invasive surgery in patients with hypertensive basal ganglia hemorrhage. METHODS: A total of 64 patients with hypertensive basal ganglia hemorrhage were enrolled in this retrospective study. They were divided into a navigation group and a traditional group based on surgical approaches. The data for the 2 groups of patients were analyzed with regard for the hematoma clearance rate, duration of surgery, duration of hospitalization, Glasgow Outcome Scale score at discharge, Barthel index score at 6 months, and postoperative complication rates for rebleeding and pneumonia. RESULTS: There were no significant differences in basic characteristics between the 2 groups (P > 0.05). The hematoma clearance rate was significantly lower in the navigation group (49.18 ± 16.76%) than in the traditional group (84.29 ± 6.91%, P < 0.01). The duration of surgery and duration of hospitalization were significantly shorter in the navigation group (55.00 ± 11.89 minutes and 24.25 ± 7.1 days, respectively) than in the traditional group (156.38 ± 47.9 minutes and 32.63 ± 9.8 days, respectively; both P < 0.01). There were also significant differences between the 2 groups in Glasgow Outcome Scale scores (P = 0.006). The Barthel index scores were significantly greater in the navigation group (73.13 ± 18.76) than in the traditional group (57.63 ± 26.63, P < 0.05). There were no significant differences between the 2 groups in the complication rates (P > 0.05). CONCLUSIONS: Under certain conditions, compared with standard craniotomy and hematoma evacuation, navigation-guided hematoma puncture aspiration and catheter drainage is simple, effective, and safe as a treatment for hypertensive basal ganglia hemorrhage.

Hyperbaric oxygen therapy of air embolus in the cerebral venous sinuses after intracranial surgery: a case report.

A case with cerebral venous air embolism (CVAE) after neurosurgery and treated with hyperbaric oxygen therapy (HBOT) is presented. This is a rare and potentially fatal complication that neurosurgeons should be aware of. A 52-year-old male was diagnosed with an intracerebral hematoma. An emergency evacuation of the hematoma was performed with a craniotomy and the postoperative CT scan showed a complete evacuation of the hematoma, but it also revealed a CVAE. The patient was immediately referred to HBOT and received three sessions within 48 h. The CT scan after the first HBOT showed no CVAE, venous thrombosis, or new hematoma.

Auricular haematoma. / Ørehematom.

Auricular haematomas typically occur as a result of the auricle being pulled or subjected to blunt trauma in association with contact sports, accidents or violence. An auricular haematoma requires prompt surgical intervention to avoid cauliflower ear, also known as «wrestler's ear¼. A cauliflower ear is a permanent deformity made up of connective tissue and cartilage.

Flexible Endoscopic Aspiration for Intraventricular Casting Hematoma.

BACKGROUND: Conventionally, patients suffering a massive intraventricular hemorrhage have undergone external ventricular drainage. However, long-term or repeated drainage increases the risk of complications due to infections or shunt dependency. Neuroendoscopic surgery may offer some advantages over more conventional procedures. METHODS: Thirteen patients suffering intraventricular hematoma associated with intracerebral hemorrhage, treated in our hospital between April 2011 and March 2014, were reviewed retrospectively. Casting hematomas in the ventricles were manually aspirated using a flexible endoscope. The timing of the operation, period of post-endoscopic ventricular drainage, additional internal shunt surgery, 3-month post-surgical outcome, and critical complications were evaluated. RESULTS: Two patients (treated during our earliest use of endoscope) who underwent surgery on the 7th and 16th day post-onset required subsequent cerebrospinal shunt surgery. In contrast, of the 11 patients who underwent endoscopic surgery on the day of onset, only 1 patient required an additional, third ventriculostomy due to a secondary obstruction of the aqueduct by adhesive fibrous membranes. After 3 months, all six patients with mRS scores of 2-3 satisfied all the following criteria: initial Glasgow Coma Scale scores higher than 8, flexible endoscopic surgeries performed on the day of onset, and period of ventricular drainage of less than 4 days. CONCLUSIONS: Early surgical intervention using a flexible endoscope and short period of post-surgical drainage can be highly effective for patients suffering from casting intraventricular hematomas associated with intracerebral hemorrhage. The advantages of this treatment may be a less invasive procedure, ICP control in the acute phase, breaking away from ventricular drainage in the early stage, and prevention of hydrocephalus or intracranial infectious complications in the long term.

[Analysis of the incidence and causes of repeated surgical interventions in patients with early complications electrotherapy - 1 center experience from the period 2012-2015].

Baclground: Due to increasing number of patients treated by cardiac implantable electronic devices we observe increasing number of complications after these procedures Material and methods: We analysed causes of early surgical revision of implantable devices connected with 1673 procedures of implantation (871 procedures) or exchange (802 procedures) of pacing systems (PM), cardioverter-difibrillators (ICD) and resynchronisation systems (CRT) in one local centre of electrotherapy in years 2012 to 2015. We characterised risk factors and its influence on encountered complications. Results: In analysed period 72 reinterventions after implantations or exchanges of PM/ICD/CRT were performed. Main causes of early complications were: lead malfunction (2.5%), including the dislodgement of the leads in 1.9%, pocket hematoma (1.4%) and other abnormalities of the pocket (0.4 %), including pocket infections in 0.2%. The most important risk factors of early complications were often implantations of the leads with passive fixation and anticoagulation therapy in perioperative period. Conclusions: The knowledge of the early complications after implantations and exchanges of PM/ICD/CRT should improve the safety of procedures through more often used of the leads with active fixation and properly preparation of the patients requering the antithrombic therapy.

Management of complications and compromised free flaps following major head and neck surgery.

Microvascular free flaps are preferred for most major head and neck reconstruction surgeries because of better functional outcomes, improved esthetics, and generally higher success rates. Numerous studies have investigated measures to prevent flap loss, but few have evaluated the optimal treatment for free flap complications. This study aimed to determine the complication rate after free flap reconstructions and discusses our management strategies. Medical records of 260 consecutive patients who underwent free flap reconstructions for head and neck defects between July 2006 and June 2010 were retrospectively reviewed for patient and surgical characteristics and postoperative complications. The results revealed that microvascular free flaps were extremely reliable, with a 3.5 % incidence of flap failure. There were 78 surgical site complications. The most common complication was neck wound infection, followed by dehiscence, vascular congestion, abscess, flap necrosis, hematoma, osteoradionecrosis, and brisk bleeding. Twenty patients with poor wound healing received hyperbaric oxygen therapy, which was ineffective in three patients who eventually experienced complete flap loss. Eleven patients with vascular congestion underwent medicinal leech therapy, which was effective. Among the 78 patients with complications, 44 required repeat surgery, which was performed for postoperative brisk bleeding in three. Eventually, ten patients experienced partial flap loss and nine experienced complete flap loss, with the latter requiring subsequent pectoralis major flap reconstruction. Microvascular free flap reconstruction represents an essential and reliable technique for head and neck defects and allows surgeons to perform radical resection with satisfactory functional results and acceptable complication rates.